A CASE OF HIRSCHSPRUNG'S DISEASE

Treatment

A 7 Years Old South Indian Girl Consulted Me On 15th April 2000 With The Following Complaints:

Chronic constipation+3; Since birth. Passes stool once in 3-4 days. Sometimes she had to take enema or pass a finger to facilitate passage of stool. Ineffectual urging to pass stool. When the urge comes, she has to strain a lot. Sometimes she passes stool involuntary in clothes+3.

In 1994 when she was about 1½ years old, she suffered from severe constipation. They consulted a surgeon at Chennai who did rectal biopsy.

Rectual Biospsy Report

Ganglion cells are not seen.

Diagnosis

He did stretching of rectum to relieve the patient temp. and advised for further surgery. Thereafter they consulted a renowned gastroenterologist of Baroda who confirmed the diagnosis and advised for surgery.

So now What is HIRSCHSPRUNG'S DISEASE?

(SYN. Primary or true megacolon, congenital aganglionic megacolon.) . Hirschsprung’s disease is evident from birth. It is the commonest cause of intestinal obstruction in the new born and is more frequently in male (4:1). In 90% the signs appear within three days of birth; only in 1% are they delayed until past the first birthday. PR examination reveals an empty rectum. In contrast, acquired megacolon shows a fully loaded rectum and soiling.

Clinical Features:

Absolute constipation, with unable to pass stool for days together. Abdominal distention. Loud borborygmus and visible peristalsis. Fecal vomiting can occur.

PATHOLOGY:

Hirschsprung's disease is characterized by enormous dilatation and hypertrophy of pelvic colon. The pelvic colon is elongated and thickened and its blood vessels are large and prominent. The mucosa is chronically inflamed and frequently ulcerated.

Historical Examination:

Complete absence of parasympathetic ganglionic cells.

Radiography:

Coning as well as dilatation, above the contracted segment, is apparent.
It can be treated surgically. Temporary relief is obtained by small enema, or passing a finger which leads to passage of spontaneous stool.

Case History of The Patient:

PAST HISTORY:   Recurrent Bronchitis.
FAMILY HISTORY:
Father – A – Healthy.
Mother – A – Healthy.
MGF – D – Diabetes.
MGM – A – Diabetes.
PGF – A – Renal failure, Hypertension.
PGM – D – Diabetes.
Younger sister – A – Recurrent URTI.

PERSONAL HISTORY:

Appetite: Very less. Desire: Fried food+3, Sweets+2, Milk, Papad, Wafers+3.
Aversion: Certain Vegetable esp. Brinjal.
Urine: Normal.
Perspiration: Normal.
Sleep: Sound.
Dreams: No specific.
Thermal: Chilly.

LIFE SITUATION & MENTAL STATE:

The child is born in a south Indian family. Her father is working in a private company and mother in Gujarat refinery. She has one younger sister aged 1½ years old. She is very mild & very careless+2 regarding her things and books. She is not concerned regarding her dressing also. In school she is like to take leadership in all activities. She doesn’t like to do things under someone’s leadership.

She is very loving and caring. Her mother said that she takes care of her younger sister as if being elder she has all the responsibilities of her sister+2. When her mother had conceived for the second time, she took care of her mother in such a nice manner that all family members were surprised to see her. She loves reading, drawing, craft and dancing+2. She always comes first in her class. She likes to remain in company of elder people+2. She likes to participate in programs held for elder children. She always like to play alone+2. Does not like if anyone plays with her.

OBSERVATION:

She is very loving and caring. Her mother said that she takes care of her younger sister as if being elder she has all the responsibilities of her sister+2. When her mother had conceived for the second time, she took care of her mother in such a nice manner that all family members were surprised to see her. She loves reading, drawing, craft and dancing+2. She always comes first in her class. She likes to remain in company of elder people+2. She likes to participate in programs held for elder children. She always like to play alone+2. Does not like if anyone plays with her.

While taking interview, she talked very much+2 and was very fast in speaking+2. She was not sitting in one place+2 and was roaming in the consulting room. She was constantly moving her hands while answering+3. When she was asked something she made faces as if she cannot understand anything+2.

After Evaluating case I find the following rubrics for Repertorization.

Treatment:

PLUMBUM MET 200 – III Doses. Constipation - reduced and urge to pass stool on alternate day. Gradually constipation was relieved to 90%, but passing stool involuntary was SQ. Then, PLUMBUM MET 1M was given. Gradual improvement with total removal of her constipation 2 years back. Till date the patient has no complain and passes stool regularly.